1275919870 NPI number — SUNRISE PEDIATRIC DENTISTRY PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275919870 NPI number — SUNRISE PEDIATRIC DENTISTRY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNRISE PEDIATRIC DENTISTRY PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275919870
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3650 E. 1ST AVENUE
Provider Second Line Business Mailing Address:
STE. 301
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80206-5507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-660-2467
Provider Business Mailing Address Fax Number:
206-312-2950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3650 E 1ST AVE
Provider Second Line Business Practice Location Address:
STE. 301
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80206-5500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-660-2467
Provider Business Practice Location Address Fax Number:
206-312-2950
Provider Enumeration Date:
08/05/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CRESPI
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
DIANA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
720-660-2467

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  10769 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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